Provider Demographics
NPI:1144349036
Name:ROUSE'S PHARMACY #15
Entity type:Organization
Organization Name:ROUSE'S PHARMACY #15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:985-580-2525
Mailing Address - Street 1:1410 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3935
Mailing Address - Country:US
Mailing Address - Phone:985-580-2525
Mailing Address - Fax:985-580-0469
Practice Address - Street 1:1410 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3935
Practice Address - Country:US
Practice Address - Phone:985-580-2525
Practice Address - Fax:985-580-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4596IR183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1268488Medicaid
LA1268488Medicaid